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MEDICARE is the ISSUE - alyburns' (aka sideburns & alyjude) Hiding Place
If you spoke faster than David Hewlett you’d travel back in time: Michael Shanks
But the Democrats don't have a clear message yet - scratch that - they don't have a UNIFIED message yet. Half the Democrats in Congress say: 

"We will NOT touch Medicare - it is SAFE and this is NON-NEGOTIABLE."

The other half have another piece of the Medicare puzzle, namely reforming the system in order to do away with insurance fraud and abuse - but unfortunately, they've been unable to adequately express the fact that A) they have no intention of doing away with Medicare, while B) recognizing the need to "clean it up" and end the waste and fraud. They're afraid to use the word, "CHANGE" in the same sentence as Medicare; afraid it will scare us as much as Ryan's 'voucher' program (which is, to put it bluntly, a privatized and thus "for profit" system).  They need to kill the word "CHANGE" and replace it with "IMPROVE".


So, Democrats and President Obama, listen up. As a Medicare recipient, I actually know how to do the above. No, really, I do. *g*

First of all, for the next year and a half, ALL Democrats MUST be united in saying over and over again that they will NOT touch Medicare as WE KNOW IT, that they will not put Medicare on the table for negotiation with the Republicans EVER. That must be their primary message. Medicare for today and tomorrow will remain SAFE.  But - at the same time - they must find a way to easily explain the intention to IMPROVE Medicare; to improve the care seniors receive while ensuring that insurance companies don't continue to cheat the government. And that's the issue.

One of the biggest fraud issues is with the health care providers. When you go on Medicare, you can go to any doctor you choose (for now, we'll leave Medicare Advantage out of the equation) and most seniors spend a great deal of time trying to choose the right provider - the one that will have the lowest costs (as in co-payments, etc.).

NOTE: When I say "Health Care Providers", I mean providers like Kaiser, Cigna, Aetna, Monarch, Blue Shield, Health Net, Well Care, etc.

As it can work now, when you visit your doctor, what happens to you isn't necessarily what the doctor may report to your health care provider and definitely not always what the provider reports to Medicare for reimbursement. Your doctor may do nothing but take your blood pressure, but the provider may send in a bill for a test you never received. This is a big chunk of what is costing our government so much money within the Medicare system. There are other abuses as well, obviously, but that's the largest. It's also the easiest to fix.

So, to President Obama and Congress, well, listen up. *G*

Right now, I receive a quarterly statement that shows the prescriptions I 'purchased' in the previous three months. It reports what I paid (if anything) and what portion my provider paid. I check it religiously to ensure it's correct and then I file it. Okay, so this same process should be expanded to include the actual care I receive. A process to be used by Medicare, our physician and the provider in order to establish an easy 'check and balance' system.

It should work something like this: When you visit your physician, at the conclusion, you would receive a 'receipt' generated via codes that shows what was ordered, what was done, etc. If your doctor took blood, then your 'receipt' would show how many and which tests were ordered. Then your doctor would naturally send the same info to your provider (they already do this, of course and the provider sends their report to Medicare for reimbursement). But here's where we'd add another step: Whether monthly or quarterly, Medicare would send each member a statement showing what was reported to them regarding your care; a report that you would compare with your 'receipts' to ensure everything was reported correctly, and thus paid properly.

Can you see how this could and would help stop the fraud and abuse?

"Wait, this statement says I had an MRI in May - I haven't had an MRI in over five years!"

"Hey, this statement says that four different tests were run on the vial of blood taken last month, but all my doctor was checking were my TSH levels as it says right here on my receipt!"

"Cool, it matches perfectly!"

If you find a problem, the Medicare website would have a section for reporting the discrepancy (or for those without computers, a phone number), and Medicare would then take over by dealing directly with either (or both) the doctor/provider to correct the report and, if necessary, ensure the provider refunds the Medicare bank. *g*

With a system like that in place (and it would be both easy and cost effective. I know because I instituted a similar process in order to report things like miles driven and students transported to my customers; the school districts. And, btw, for the same reason: so the districts could receive their government transportation funds. Without such a system, which was completely automated, it would have been very easy for:
  1. my drivers to cheat me in order to pad their time and increase their pay
  2. for me to 'enhance' mileage and pupil count in order to increase my receivables from each customer
  3. and for the district to 'enhance' their numbers in order to receive a larger chunk of Federal Transportation money and ensure their yearly transportation budget either stayed the same or was increased
A system as outlined above would probably save - billions? *nods* And that alone would ensure that Medicare would be able to continue long into the future of our children, their children and their children's children. Besides, we, the patients, should be in charge of our care anyway, right? We should know what's happening, what the doctor/s is/are doing, ask questions, and keep records of what's been done to - and for - us as well as our out-of-pocket expenses.



5 comments or Leave a comment
seikaitsukimizu From: seikaitsukimizu Date: May 26th, 2011 05:01 am (UTC) (Link)
This is gonna sound a bit cliche, but have you emailed our House and Congress representatives? They're very receptive and interactive with suggestions.
alyburns From: alyburns Date: May 27th, 2011 12:00 pm (UTC) (Link)

I've cleaned it up and posted on my political blog, and

tomorrow (which is now today - couldn't sleep) hopefully my arm will feel well enough to email various government avenues and yes, my representatives. :) And trust me, I doubt that the House would be that receptive - they're being pushed by private companies that want this business. :( That's what folks are just beginning to realize: that what the voucher system really amounts to is the ability to bring big profits to those who have financed certain campaigns. :(
MY House Rep would be most definitely NOT be interested - I'm in the California 42nd and my rep is Republican Gary Miller :) Here's a quote from his page: "Congressman Miller favors market-based solutions instead of government-sponsored health care in order to reduce the number of uninsured Americans."

As you can see, he's for privatizing. Not surprising since he had a SuperPac from the Insurance Industry. His total money (so far revealed) for his 2009-2010 campaign was:
Total Individuals PAC's
$39,800 $5,900 $33,900

Health Professionals:
$30,200 $6,700 $23,500

Lobbyists (which would include the Medical Insurance Industry - see how they can contribute twice?):
$25,250 $24,250 $1,000

Total within the ranks of the Medical Profession is almost $100,000 but his total PAC contributions were over $360,000. Additionally, the money he raised in 2010 was the highest he'd ever attained, but that's not surprising. :(

This kind of information is what all Americans should know about their Reps and it, like their voting records, are so easy to find, but most won't bother to take the time. :(

Edited at 2011-05-27 12:18 pm (UTC)
(Deleted comment)
alyburns From: alyburns Date: May 27th, 2011 11:56 am (UTC) (Link)

And of course, the Insurance companies

have the third or fourth most powerful Lobby. :) BUT, any attempt to block such an easy fix would clearly show them up for what they are: Greed mongers. So I think it could be handled easily, I really do. It's hard to say no to something that will cost them little to nothing and if they're honest, it's easy to say, "Then what's the fear?" *G*
angelsmile1 From: angelsmile1 Date: May 27th, 2011 04:11 am (UTC) (Link)
Have you considered posting or emailing this to someplace like whitehouse.gov? It sounds like a good idea and who knows who might listen.
alyburns From: alyburns Date: May 27th, 2011 11:57 am (UTC) (Link)

Yes, I cleaned it up and posted at my political blog

and tomorrow, when my arm is feeling better, will go through several governmental avenues to get this out there. :) I find as I get older, I get, well, pushier. :)
5 comments or Leave a comment